Abstract
BackgroundDifferences between adult patients with severe early-onset and late-onset asthma have not been well studied.ObjectivesTo determine the phenotypic distinction regarding age at onset in patients with severe asthma.MethodsThe present study enrolled thirty-two patients with severe early-onset (onset age < 12 years) asthma and thirty-two patients with severe late-onset (onset age > 12 years) asthma. Severe asthma was defined according to Global Initiative for Asthma criteria. The clinical, spirometric, and laboratory parameters were collected for group comparisons.ResultsAmong the 64 patients included (mean age, 46.22 ± 13.90 years; 53.1% male), the mean percent of predicted forced expiratory volume in 1 s (FEV1) was 68.43 ± 20.55%. Patients with severe early-onset asthma had a younger age, longer duration of asthma, higher rate of family history, and better small-airway function (MEF25% and MMEF75/25%) compared with severe late-onset asthma. Furthermore, levels of serum IL-17 and sputum neutrophil percentage were significantly higher for patients with severe early-onset asthma (P = 0.016, 0.033, respectively). Multiple logistic regression analysis revealed that increased serum IL-17 (odds ratio = 1.065, P = 0.016) was independently associated with severe early-onset asthma. The combination of serum IL-17 and sputum neutrophil percentage yielded a sensitivity of 80.0% and a specificity of 86.7% for identifying patients with severe early-onset asthma.ConclusionsPatients with severe early-onset asthma exhibit elevated levels of serum IL-17 and sputum neutrophil percentage, suggesting a potential role in the pathogenesis of severe early-onset phenotype.
Highlights
Asthma is a heterogeneous disease of airways that is characterized by chronic airway inflammation, airway hyperactivity, reversible bronchoconstriction, and tissue remodeling [1]
Subjects with early-onset asthma had higher MEF25% and MMEF75/25%, and were more sensitized to Dust mites (53.1% vs. 21.9%, P = 0.013) and Dermatophagoides farina (43.8% vs. 18.8%, P = 0.038)
Differential levels of inflammatory biomarkers between groups Compared to the patients with late-onset asthma, patients with early-onset asthma exhibited a higher median level of serum IL-17 [52.96(47.99, 105.50) vs. 44.75(20.81, 54.99) ng/L, P = 0.016], and a higher neutrophils percentage in induced sputum samples (72.04 ± 26.90 vs. 53.61 ± 27.89%, P = 0.033)
Summary
Asthma is a heterogeneous disease of airways that is characterized by chronic airway inflammation, airway hyperactivity, reversible bronchoconstriction, and tissue remodeling [1]. Monitoring the control level of asthma patients and identifying their predisposing factors can adjust the treatment plan as soon as possible to prevent further exacerbation. Mild asthma is the most common form, about 8% of mild patients will develop into moderate to severe asthma [3]. Those with severe asthma have more frequent acute attacks, and the clinical symptoms and lung function deteriorate more seriously [1]. Early prevention and treatment of severe asthma are still major challenges facing physicians in China. Differences between adult patients with severe early-onset and late-onset asthma have not been well studied
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